A new report offers guidance to physicians weighing the various therapeutic strategies available to treat women who experience a depressive disorder during pregnancy.
The report, developed by a work group convened by the American Psychiatric Association and the American College of Obstetricians and Gynecologists (Yonkers KA et al. Gen Hosp Psychiatry. 2009;31[5]:403-413; Obstet Gynecol. 2009;114[3]:703-713), comes at a time when they estimated that up to 23% of women experience a depressive disorder while pregnant and that about 13% of women (as of 2003) took an antidepressant at some point during pregnancy—double the rate seen just 4 years earlier.
The report offers 3 treatment algorithms to assist physicians in managing 3 groups of patients: those who are contemplating pregnancy while undergoing pharmacological treatment for depression, those who experience an episode of a major depressive disorder during pregnancy and who are not taking antidepressants, and those with a major depressive disorder who are pregnant and currently taking antidepressants. Such algorithms should help physicians identify which individuals will need aggressive pharmacological treatment, which ones can undergo a tapering of drug therapy (while being monitored for relapse), and which individuals can be treated with psychotherapy alone during their pregnancy.
The document includes an assessment of the current state of research on maternal depression and adverse reproductive outcomes, the impact of antidepressants on birth outcomes, the use of electroconvulsive therapy during pregnancy, and diagnosing a depressive disorder in perinatal women. The work group, which included a developmental pediatrician, noted that depressive symptoms and antidepressant exposure are associated with fetal growth changes and shorter gestations, that short-term neonatal irritability and neurobehavioral changes are also linked with maternal depression and antidepressant treatment, and psychotherapy alone is an appropriate treatment for some pregnant women.
The report also includes a “frequently asked questions” section in which the authors offer guidance on such topics as the absolute contraindications to stopping selective serotonin reuptake inhibitor therapy during pregnancy and which pregnant patients are candidates for electroconvulsive therapy.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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